胃癌と非癌粘膜の白色球状外観（white globe appearance）の 差異に関する検討

Aim: This study aimed to investigate the difference between white globe appearance (WGA) in patients with gastric cancer and non-cancerous gastric mucosa. Methods: In this study, we retrospectively analyzed the clinical and pathological features of 41 patients with WGA in the stomach. Results: WGA was found in patients with gastric cancer (n = 18) and those without gastric cancer (n = 23). Seven patients with gastric cancer (38.9%) and 17 patients without gastric cancer (73.9%) had been taking proton pump inhibitors (PPIs). Histologically, in the gastric cancer group, cystic dilatation of the gland was observed in 12/18 patients (66.7%), intraglandular necrotic debris (IND) in 12/18 patients (66.7%), and parietal cell protrusion (PCP) in 1/18 patients (5.6%). On the other hand, in patients without gastric cancer, cystic dilatation of the gland was observed in 8/14 patients (57.1%) and PCP in 7/14 patients (50.0%). IND was not found in patients without gastric cancer. In patients with autoimmune gastritis (n = 2), cystic dilatation of the gland duct was observed in both cases, but neither PCP nor IND was found. Some of the patients without gastric cancer had concomitant pathological features, including autoimmune gastritis (n = 2), scarring after endoscopic submucosal dissection (n = 2), adenoma (n = 1), lanthanum deposition (n = 1), and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in the stomach (n = 1). Conclusions: These results suggest that the pathogenesis of WGA in patients with gastric cancer may be different from that of non-cancerous gastric mucosa. Using PPIs may contribute to the development of WGA in patients without gastric cancer.